Neurogenic Bowel Dysfunction in Children and Adolescents.

Giovanni Mosiello,Udo Rolle,Marc A Benninga,Shaista Safder,David Marshall

doi:10.3390/jcm10081669

Abstract

Neurogenic/neuropathic bowel dysfunction (NBD) is common in children who are affected by congenital and acquired neurological disease, and negatively impacts quality of life. In the past, NBD received less attention than neurogenic bladder, generally being considered only in spina bifida (the most common cause of pediatric NBD). Many methods of conservative and medical management of NBD are reported, including relatively recently Transanal Irrigation (TAI). Based on the literature and personal experience, an expert group (pediatric urologists/surgeons/gastroenterologists with specific experience in NBD) focused on NBD in children and adolescents. A statement document was created using a modified Delphi method. The range of causes of pediatric NBD are discussed in this paper. The various therapeutic approaches are presented to improve clinical management. The population of children and adolescents with NBD is increasing, due both to the higher survival rate and better diagnosis. While NBD is relatively predictable in producing either constipation or fecal incontinence, or both, its various effects on each patient will depend on a wide range of underlying causes and accompanying comorbidities. For this reason, management of NBD should be tailored individually with a combined multidisciplinary therapy appropriate for the status of the affected child and caregivers.

Highlights

We suggest to healthcare providers (HCPs) the clinical situations in childhood where neuropathic bowel dysfunction (NBD) should be considered and investigated, and report recommendations for care, in order to improve the clinical outcome of management globally, as well as identifying issues for future research
A similar group decided to compile this follow-up report based on the current literature and personal experience, in order to offer a practical instrument for all HCPs involved in diagnosis and management of NBD in pediatrics, using a modified Delphi method [14]
The causes and presentation of a neurogenic bowel dysfunction (NBD) in children and adolescents are different from adult forms

Summary

Introduction

Chronic constipation and fecal incontinence often coexist, sometimes with “overflow” diarrhea (where solid stool impacted higher up the rectum or colon only allows watery stool past it, which is very difficult for even a neurologically intact anal sphincter to retain). This results in a frustrating situation for both patients and caregivers, especially in a neurogenic scenario, commonly defined as neurogenic or neuropathic bowel dysfunction (NBD) [4]. We suggest to healthcare providers (HCPs) the clinical situations in childhood where NBD should be considered and investigated, and report recommendations for care, in order to improve the clinical outcome of management globally, as well as identifying issues for future research

Methods

Results

Discussion

Conclusion